Modified Parasagittal Approach | Supraclavicular Brachial Plexus Block | Out-of-Plane | Ultrasound
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- เผยแพร่เมื่อ 20 ม.ค. 2023
- In this video, I have demonstrated the out-of-plane technique of ultrasound-guided Supraclavicular Brachial Plexus Block.
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The owner of this channel (Block Onn!) has checked with the latest sources believed to be reliable to provide information with the standards accepted at the time of recording and uploading the videos. This is an abridged version of the vast knowledge of Regional Anaesthesia. However, medicine is an ever-changing and evolving science. Viewers and subscribers are encouraged to confirm the information contained herein with other reliable sources. This video is for educational purposes only. It is not a substitute for professional medical advice or consultation with a health care professional. To the fullest extent of the law, the owner and this channel do not assume any liability for any harm, injury, and/or damage to persons, patients, volunteers, or property arising out of or related to any use of the techniques demonstrated in the videos on this channel.
The modified Parasagittal Approach of
Supraclavicular Brachial Plexus Block:
doi.org/10.4103/sja.SJA_753_18
Link to the previous video on in-plane technique of Subclavian perivascular brachial plexus block:
th-cam.com/video/U3VqTTx8sd0/w-d-xo.html
Kindly provide blind block
Land mark guided
Sorry Dr. Vijay. Paresthesia guided block are not recommended anymore.
You can check out PNS guided or Ultrasound-Guided blocks from my channel.
Thanks and regards.
Dear Dr Tuhin,
The technique looks good..
But,
Two views together should not be there on the same screen..
Please change slides slowly
Thanks
Thank you madam for your feedback.
I used that slide to explain the difference between the two techniques. Otherwise it will be difficult to understand the advantages and follow.
Sir, I agree with advantage of reducing incidence of plueral injury in this technique, meanwhile rises concern of perineural injury when we inject into cluster of brachial plexus. Any means to address that concern.
Thanks Dr. Harish. Totally agree with your views.
Few points I have mentioned in video:
1. Go slow and use hydrodissection.
2. Target hyperechoic area and use LA jet to displace the neural elements and create space for needle tip.
We have been using this technique for more than 15 years. Not a single incidence of nerve injury so far. Because we follow these two basic points.
One more point I want to mention here for you,
3. If you are touching or injecting in neural elements, patients will immedeately complain of pain or you will see swelling of hypoechoic neural elements on ultrasound screen. You should stop the injection immediately and adjust your needle tip.
Moreover, In coronal oblique technique, we are getting a transectional view. More surface area of nerve is exposed to the needle tip. More chance of nerve injury as compared to modified parasagittal approach as we are seeing a cross sectional view here.
Thanku for valuable comment sir 😊
Will this approach make sure there is no ulnar sparing?
Which is more important
Ulnar sparing or safety?
In case of sparing, you can always block ulnar nerve in axilla.
we have been using this technique for more than 10 years. we haven't experience any sparing so far.
How much drug to give?
Hi Dr. Praveen.
I have mentioned in video that ergonomics and requirements are similar to the in-plane technique (previous video)
No difference in drug volume.
Same 20-25 ml
According to literature volume above 15 ml is good for this approach.